General Permits (5307)

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Applicant Name _
Address
City
Project Location
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CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT �� JUL 3 8-1997
as authorized b the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resouas'Contmis5ion- -
in an area of environmental concern pursuant to 1S-=AC`Subc1 ap 4�-0203.
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'ounty, State Road, Wa
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Phone Number C 1Vl, 7�>�
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Type and Dimensions of Project rm amQ
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 1-6-WCAC_7KF..0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
This certification of exemption from requiring a CAMA permit is
valid for'904ays from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: f'„ UCVtZ. )
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Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
CAMA Official's signature
Issuing date
\qq1
Expiration date
AtTTc�i m cn""t:'°I'S°"fQonh-Camfi na-Admin istrative-Co-d e• 7 K-.0203